Benign Paroxysmal Positional Vertigo

(BPPV; Benign Positional Vertigo, BPV; Positional Vertigo of Barany)

Definition

Vertigo is a feeling of movement or spinning when you are still. Benign paroxysmal positional vertigo (BPPV) happens when the vertigo is caused by changes in the position of the head. This might include standing after bending down, turning the head in bed, or extending the neck to look up. People with BPPV can often identify which moves cause the most problems.

Causes

The inner ear contains tiny crystals. These crystals can sense movement and help you keep your balance. BPPV occurs because of a shift in location of these crystals or the clumping of these crystals. When this happens, your brain gets signals that you are moving when you are really not moving. This causes the feeling of movement.

In some cases, the cause of BPPV is unknown. In others, it may be caused by:

Head injury

Viral infection

Disorders of the inner ear

Prolonged immobility of the head

Age-related changes to inner ear

Risk Factors

Increasing age increases your chances of getting BPPV.

Symptoms

Symptoms may include:

Sensation of spinning or rotation when you change head position that last less than one minute

Loss of balance

Nausea

Vomiting

Ringing or buzzing sounds in the ear

Vision or hearing problems

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Part of the process will be to eliminate other disorders. Your doctor may recommend tests to help determine the cause of vertigo symptoms. Tests may include:

Blood pressure test, both lying down and standing up

Blood tests

Auditory tests

Vision tests

Dix-Hallpike maneuver—moving your head or body in certain ways to test response

Treatment

Many times BPPV can resolve on its own, usually within months of onset. Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Vestibular Rehabilitation

Your doctor may suggest specific vestibular exercises.
These exercises use a series of eye, head, and body movements to get the body used to moving without dizziness.
You may work with a physical therapist to learn these.

Canalith Repositioning

This procedure (also called the Epley maneuver) is done in your doctor’s office. Your doctor will move your head in different positions to try to resettle the tiny crystals. The procedure is sometimes repeated and you may be taught how to do it at home.

Surgery

Some people with BPPV undergo surgery. During surgery, a piece of wax may be used to plug one area of your ear. This will prevent fluid in your inner ear from moving. Another type of surgery that may be done involves cutting the nerve from the inner ear.

9/10/2014 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: University of Texas at Austin School of Nursing, Family Practitioner Program. Evaluation of vertigo in the adult patient. Austin (Tx): University of Texas at Austin, School of Nursing; 2014 May. 19 p. Available at: http://www.guideline.gov/content.aspx?id=48220#Section427. Accessed September 10, 2014.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.